Dissociated empathy and utilitarian moral judgment in borderline personality disorder

Abstract Borderline personality disorder (BPD) is characterized by affective instability, disrupted empathy, and self-processing. In this study, we aimed to investigate moral decision-making and its association with empathy in BPD compared to Control group (CG). 112 participants, 45 BPD, and 67 CG were recruited. They filled out a demographic questionnaire and completed the moral scenarios and Interpersonal Reactivity Index. We mainly used regression-based t-test, linear discriminant analysis, and canonical correlation analysis to analyze the data. Patients with BPD made more utilitarian decisions in all the moral scenarios (P-value < 0.05) and showed poorer perspective-taking , greater personal distress and fantasy (P-value < 0.05) with preserved empathic concern compared to CG. Morality, Empathy, and a combined Morality Empathy score had classification accuracies of 73%, 79%, and 84%, respectively, between BPD and CG groups.Canonical correlation analysis showed a significant association between moral and empathy scores’ spaces only in the BPD group. Most of empathy dimensions were significantly correlated only in the CG empathic concern and personal distrress, and fantasy (P-value = 0.002 and < 0.001). The a typical structure of empathy in BPD may be related to differences in moral decision-making, reflected in increased utilitarian responses.